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States seeking to deter the abuse and diversion of controlled narcotic prescription pain medications should look to New York state's efforts to implement a “real-time” drug-monitoring registry with teeth.
Beginning next year under New York's recently adopted reforms, doctors will have to check a registry for a patient's prescription history and enter information about any narcotic prescriptions they write for patients.
Pharmacists, in turn, will have to check the database to verify that a legitimate doctor-ordered prescription exists before filling a patient's order. They also will have to input information when they provide a prescription for Schedule II, III, IV and V narcotics.
And by December 2014, electronic prescribing will be required for controlled substances, according to the office of New York Attorney General Eric T. Schneiderman.
Regulations governing how the law will be carried out still must be developed, but the law will affect prescription pharmaceuticals paid for by various forms of insurance, including workers compensation and group health plans, according to several sources.
The database will prevent patient “doctor shopping” and the filling of the same prescription at multiple pharmacies, said Joe Paduda, president of CompPharma L.L.C., a workers comp pharmacy benefit management company consortium that supports New York's effort.
New York's Internet System for Tracking Over-Prescribing, or I-STOP, also will help identify multiple doctors prescribing to a single customer, said Mr. Paduda, who also is principal of workers comp managed care consultant Health Strategy Associates in Madison, Conn.
In addition, the mandate to electronically prescribe narcotics will eliminate diversion through forgery and theft, according to the CompPharma.
Most states already have prescription data monitoring programs, referred to as PDMPs, or prescription monitoring programs, called PMPs, experts said.
But many of those programs are “useless” because compliance is voluntary, Mr. Paduda said.
The programs “vary wildly from state to state,” he said. “I would say New York's is probably the most effective, the most clearly thought-through, the most targeted.”
Bruce Wood, Washington-based associate general counsel and director of workers compensation for the American Insurance Assn., said he agrees that many other state PDMPs are “useless.”
If they were effective, the United States would not be facing a prescription pain medication crisis, Mr. Wood said.
Death from prescription painkillers has reached epidemic levels, causing more overdose deaths than heroin and cocaine combined, according to the U.S. Centers for Disease Control and Prevention.
The agency reported last year that enough prescription painkillers were prescribed in 2010 to continuously medicate every U.S. adult for a month.
The Washington-based Coalition Against Insurance Fraud, meanwhile, says “insurance fraud is the main financier and enabler of drug diversion.”
Improving the way prescription painkillers are prescribed can reduce the misuse and abuse of prescription pain medications, according to the CDC.
Prescribing of narcotic pain medications is particularly common under workers comp insurance programs because of the nature of workplace injuries, said Kevin Tribout, executive director of government affairs for PMSI Inc., a pharmacy benefit manager in Tampa, Fla. Therefore, New York's new law “will definitely have a big impact on comp,” he said.
Unlike New York, most other state PDMPs lack enforcement teeth because they do not require the real-time reporting of drug dispensing, Mr. Tribout said. Some states require the reporting only within a certain number of days, weeks or even monthly.
Many states with PMPs do not have the resources to continually analyze the reports they receive, he said.
Meanwhile, the list of drugs that will require reporting in New York is much broader than the list of prescriptions many other state PDMPs require be reported, Mr. Wood said.
Additionally, some states allow only law enforcement authorities with a subpoena to access their databases, Mr. Wood said.
But in contrast, New York state will allow workers comp insurers to access the database, he said.
“It's saying that payers have a legitimate interest in (accessing) this information,” Mr. Wood said.
Other states have taken steps recently to bolster their prescription drug monitoring programs, he said.
In January, for example, Oklahoma began requiring all pharmaceutical dispensers to report the dispensing of scheduled narcotics within five minutes of delivery to a customer.
But New York's efforts stand out, he said.
“New York's legislation—not only for the significance of what it provides, but that it happened in a major state—makes a real statement about policymakers understanding the importance and gravity of (the opioid abuse) issue,” Mr. Wood said.
The adoption of I-STOP also makes New York the first state in the nation to mandate that physicians consult a database of a patient's prescription history before prescribing a Schedule II, III, or IV controlled substance, Mr. Schneiderman said.
The I-STOP legislation that Mr. Schneiderman introduced last year reformed New York's existing pharmaceutical tracking system, which had weaker enforcement capabilities.
While carving out pharmacy benefits management to a specialty provider generally lowers costs for self-funded employers, those seeking such unbundled arrangements are meeting resistance from the insurers that administer their health benefit programs.